Unintended Shifts in High-Priority Adult Heart Transplant Listings after the OPTN’s September 2025 Policy Change
6 affiliations
- 1Department of Medicine, University of Chicago, Chicago, IL
- 2Department of Medicine, Stanford University, Stanford CA
- 3Stanford Cardiovascular Institute, Stanford University, Stanford, CA
- 4Department of Public Health Sciences, University of Chicago, Chicago, IL
- 5MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL
- 6Department of Surgery, Stanford University, Stanford, CA
Abstract
The Organ Procurement and Transplantation Network amended Status 2 heart allocation criteria in September 2025, requiring documented failure of high-dose inotropes before candidates could qualify via intra-aortic balloon pump (IABP) or percutaneous endovascular ventricular assist device (PEVAD) support. Using OPTN data, we compared seasonally matched pre-policy (September 2024-June 2025, n=4,206) and post-policy (September 2025-June 2026, n=4,231) adult candidates. While standard Status 3 high-dose inotrope listings increased 2.0% to 4.1% and standard Status 2 IABP/PEVAD listings decreased 18.2% to 11.0%, Status 1 listings and Status 2 exceptions increased 7.7% to 10.6% and 17.5% to 21.5%, respectively (all p<0.001). Consequently, combined initial Status 1/2 listings were unchanged (44.5% vs 44.0%, p=0.71). Furthermore, overall transplant volume remained similar, but status at transplant shifted from standard Status 2 toward Status 2 exceptions and Status 1. Tightening standard Status 2 eligibility was associated with redistribution across high-priority pathways rather than reduced high-priority listings.
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BibTeX
@article{ramos2026unintended,
title = {{Unintended Shifts in High-Priority Adult Heart Transplant Listings after the OPTN’s September 2025 Policy Change}},
author = {Christian Ramos and Ava Horwitz and Rachel Singer and Molly White and Nikhil Narang and Kiran K. Khush and William F. Parker and Daniel J. Ahn},
journal = {The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation},
year = {2026},
month = oct,
doi = {10.1016/j.healun.2026.10.012},
url = {https://doi.org/10.1016/j.healun.2026.10.012},
note = {CC BY},
}
RIS
TY - JOUR
TI - Unintended Shifts in High-Priority Adult Heart Transplant Listings after the OPTN’s September 2025 Policy Change
AU - Christian Ramos
AU - Ava Horwitz
AU - Rachel Singer
AU - Molly White
AU - Nikhil Narang
AU - Kiran K. Khush
AU - William F. Parker
AU - Daniel J. Ahn
PY - 2026
DA - 2026/10/17
JO - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
DO - 10.1016/j.healun.2026.10.012
UR - https://doi.org/10.1016/j.healun.2026.10.012
AB - The Organ Procurement and Transplantation Network amended Status 2 heart allocation criteria in September 2025, requiring documented failure of high-dose inotropes before candidates could qualify via intra-aortic balloon pump (IABP) or percutaneous endovascular ventricular assist device (PEVAD) support. Using OPTN data, we compared seasonally matched pre-policy (September 2024-June 2025, n=4,206) and post-policy (September 2025-June 2026, n=4,231) adult candidates. While standard Status 3 high-dose inotrope listings increased 2.0% to 4.1% and standard Status 2 IABP/PEVAD listings decreased 18.2% to 11.0%, Status 1 listings and Status 2 exceptions increased 7.7% to 10.6% and 17.5% to 21.5%, respectively (all p<0.001). Consequently, combined initial Status 1/2 listings were unchanged (44.5% vs 44.0%, p=0.71). Furthermore, overall transplant volume remained similar, but status at transplant shifted from standard Status 2 toward Status 2 exceptions and Status 1. Tightening standard Status 2 eligibility was associated with redistribution across high-priority pathways rather than reduced high-priority listings.
SN - 1053-2498
SN - 1557-3117
ER -